six - Conclusions, cautions and future directions

Summary

Introduction

We started this book with some technical, economic and political questions about outcomes-based commissioning.

In Chapter Two we developed some of these questions through consideration of key theoretical debates, and argued that outcomesbased commissioning in its various guises may be theorised as a logical extension of New Public Management or marketisation. This argument has rather more traction in the UK than in the US, as the UK government has committed to ‘introducing payment by results across public services’ (Cabinet Office, 2011: 9), as part of a longstanding outsourcing and privatisation agenda (Dowling and Harvie, 2014; Dowling, 2017). By contrast, PFS is not generally seen as a form of marketisation in the US.

More generally, outcomes-based commissioning might also be theorised as policy makers’ response to complexity and risk management, and/or as a means of facilitating philanthropists and other private sector actors in social innovation. This latter motivation applies in particular to the US, as it has a different emphasis in the history of provision of public services to the UK, tending to rely rather more on private philanthropy than innovative government interventions in the provision of public goods (cf. Carnegie, 1889a and 1889b).

Drawing on the evidence presented in earlier chapters, we start this concluding chapter by addressing these questions, before going on to consider the future of outcomes-based commissioning.

The evidence to date on outcome-based commissioning

Models that encourage social innovation are attractive to governments concerned that public provision of services is resistant to reform and/or inefficient. Likewise, such models have an obvious application where government feels the private sector needs encouraging in the production of social goods. Our discussion in Chapter Five indicates both PbR/PFS in general and SIB/PFS financing in particular have provided new opportunities for the private sector to complement or substitute the public sector in the delivery and financing of social services (Gustaffson-Wright et al, 2015). However, we find that there is little clear evidence of the benefit of the PbR/PFS approach in terms of three key policy areas:

• • incentivising desired behaviour

• • complexity and risk management

• • facilitation of social innovation.